cooldudemle
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A 73 yr old male with Hx of HTN, presents with short episode of Lt. sided weakness & slurred speech. Also he has a Hx of 3 brief episodes of sudden Rt. eye vision impairment in the last month.
1)- What’s the best next diagnostic test?
A- Cerebral MRI
B- Holter monitoring
C- Visual evoked responses
D- Carotid artry doppler US
E- Conventional cerebral angiography
2)- Episodes of visual loss are related to:
A- Retinal vein thrombosis
B- Central retinal A. ischemia
C- Post. cerebral A. ischemia
D- Middle cerebral A. ischemia
E- Post. ciliary A. ischemia
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| chemamr
Moderator and PGY1
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D and B?
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| mani
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in question 1, question is ambigious, it cant be "next best" test, should be either next or best. any way if by the question next best test is meant, i would choose D and if he wants to know the best diagnostic test, answer should be E
2.B
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| mesh
Forum Guru
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i will go with A in 1st question....
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| frontal
Forum Guru
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A and B.
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| cooldudemle
Forum Newbie
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Answers are D & B. This is a classical case of extracranial internal carotid A. disease. which includes episodes of ipsilat. transient monocular blindness ( amaurosis fugax ) & contralat. TIA consisting of motor weekness. The most appropriate test to screen for carotid stenosis is Doppler us.If on doppler found to have more than 70% stenosis do angiography and endarterectomy, manage risk factors and administer asprin.
The mech. of transient monocular blindness is embolism to the central retinal A. or one of its branches. 
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| frontal
Forum Guru
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I thought it was better to ascertain the area of damage first as is done in most cases of hemiparesis. From the question it is not evident that the motor weakness is a result of TIA, but this is not to refute D as the answer.
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